针刺养阴通络法治疗糖尿病性脑梗死临床疗效观察

目的:观察针刺养阴通络法治疗糖尿病性脑梗死的临床疗效。方法:选择糖尿病性脑梗塞患者70例,随机分成2组。在基础治疗的同时,治疗组给予针刺养阴通络法治疗;对照组给予口服补阳还五汤汤药。观察2组治疗前后临床疗效、神经功能缺损程度评分。结果:总有效率治疗组为86.11%,对照组为55.88%,2组总有效率比较,差异有非常显著性意义(P <0.01);2组治疗后神经功能缺损程度评分比较有非常显著意义(P <0.01)。结论:针刺养阴通络法治疗糖尿病性脑梗死有显著疗效。     

养阴祛风通窍汤治疗儿童变应性鼻炎临床研究

目的观察养阴祛风通窍汤治疗儿童变应性鼻炎的临床疗效。方法选取2016年11月至2018年10月首都医科大学附属北京中医医院收治的变应性鼻炎患儿90例,采用随机数字表法分为两组各45例,分别给予玉屏风散和鼻渊通窍颗粒(对照组)、养阴祛风通窍汤(观察组)治疗,观察疗效。结果对照组显效18例,有效17例,无效8例,脱失2例,总有效率81.39%;观察组显效31例,有效9例,无效4例,剔除1例,总有效率90.91%。两组治疗前后临床疗效比较差异有显著性(P<0.05),且观察组总体疗效及改善鼻眼部症状(6项)、生活质量(23项)诸方面优于对照组(P<0.05)。结论两组治疗肺热上郁兼气阴两虚证儿童变应性鼻炎均具有一定的临床疗效,养阴祛风通窍汤总体疗效及对改善鼻眼部症状和生活质量方面更有优越性。     

清胃散联合针刺治疗智牙冠周炎疼痛临床研究

目的:观察清胃散联合针刺治疗智牙冠周炎疼痛的临床疗效。方法:把60例智牙冠周炎疼痛患者随机分成2组各30例,对照组给予青霉素V钾胶囊和甲硝唑片治疗,观察组在此基础上给予清胃散联合针刺治疗。观察两组治疗前后中医症状积分、VAS评分及临床疗效。结果:观察组与对照组总有效率分别为93.33%和53.33%,差异有统计学意义(P<0.05);观察组中医症状总积分及VAS评分较治疗前明显降低(P<0.05)。结论:清胃散联合针刺治疗智牙冠周炎疼痛具有显著的临床疗效。     

双氯芬酸钠联合玻璃酸钠治疗干眼症临床疗效观察

目的观察双氯芬酸钠滴眼液联合玻璃酸钠滴眼液治疗干眼症临床疗效。方法选取医院门诊2017年1月-2019年1月间诊断为干眼症的病例60例120只眼,随机分成对照组和治疗组。对照组给予物理方法治疗,如眼睑清洁热敷、睑板腺按摩等,用玻璃酸钠滴眼液滴眼,治疗组在对照组治疗基础上加用双氯芬酸钠滴眼液。治疗8周以后,观察两组的疗效。结果对照组的总有效率为73.33%(22/30),治疗组的总有效率为96.67%(29/30),对照组与治疗组比较差异有统计学意义(P 0.05)。结论双氯芬酸钠与玻璃酸钠滴眼液联合使用治疗干眼症,疗效显著。     

针药结合治疗痰湿瘀阻型缺血性中风急性期疗效观察

目的:观察针药结合治疗痰湿瘀阻型缺血性中风急性期患者60例临床疗效。方法:选取我院2016年11月～2018年10月痰湿瘀阻型缺血性中风急性期患者120例为研究对象,按随机数字表法分为对照组与观察组,每组60例。对照组给予常规西药治疗,观察组于对照组基础上给予半夏白术天麻汤联合健脾调神针刺法治疗。对比两组疗效及治疗前后日常生活活动能力量表(ADL)、美国国立卫生研究院卒中量表(NIHSS)、生活质量综合评定量表(GQOLI-74)评分。结果:观察组总有效率95.00%,明显高于对照组的76.67%(P0.05);治疗后观察组NIHSS评分低于对照组(P0.05);治疗后观察组ADL、GQOLI-74评分高于对照组(P0.05)。结论:半夏白术天麻汤联合健脾调神针刺法治疗痰湿瘀阻型缺血性中风急性期患者,可改善神经功能及日常生活能力,提高生活质量,疗效显著。     

大柴胡汤加减联合针刺治疗肝胆结石效果分析

目的:探讨应用大柴胡汤联合针刺治疗肝胆结石患者的临床疗效。方法:选取2012年12月²013年12月我中心收治的肝胆结石患者94例,随机分为对照组与观察组各47例,对照组给予熊去氧胆酸片治疗,观察组给予大柴胡汤联合针刺治疗,观察两组患者的临床治疗效果,并比较分析。结果:观察组总有效率为95.7%,对照组总有效率为59.6%,观察组优于对照组,差异具有统计学意义(P<0.05)。两组患者中胆结石、肝内胆管结石、胆总管结石的治疗效果比较,观察组均显著优于对照组,差异具有统计学意义(P<0.05)。结论:大柴胡汤联合针刺治疗肝胆结石可疏肝利胆,促进结石的溶解与排出,可降低手术痛苦,具有确切的临床应用价值。     

头部经穴梳理加针刺治疗椎动脉型颈椎病的临床观察

目的观察头部经穴梳理加针刺治疗椎动脉型颈椎病的临床疗效。方法将60例患者随机分为治疗组和对照组,各30例。对照组给予针刺治疗,治疗组在针刺基础上给予头部经穴梳理,治疗20d。观察两组治疗前后颈性眩晕症状与功能评分的变化。结果治疗后两组患者的颈性眩晕症状与功能评分均有所改善(P0.05),治疗组较对照组改善更加显著(P0.05);治疗组总有效率有效率(90.00%)高于对照组的(86.67%)。结论实施头部经穴梳理可以有效改善椎动脉型颈椎病的临床症状。     

氧雾化联合中药内服治疗干眼症的临床研究

目的对干眼症患者给予氧雾化联合中药内服及人工泪液滴眼进行治疗,分析和探讨其临床疗效。方法按照随机数字表将干眼症患者进行随机分为两组,观察组给予氧雾化联合中药内服及人工泪液滴眼进行治疗,对照组给予人工泪液滴眼治疗,对比观察两组患者的临床疗效并进行统计学分析。结果观察组的治疗有效率为85.71%(36/42),对照组的治疗有效率为65.79%(25/38),两者之间比较差异具有统计学意义(P=0.036)。结论氧雾化联合中药内服及人工泪液滴眼治疗干眼症,可以获得较满意的临床疗效。     

针刺治疗干眼症45例临床疗效观察

目的:观察针刺治疗干眼症的临床疗效观察。方法:对2016年12月至2017年4月期间于沈阳市第四人民医院眼科门诊就诊患者45例患者加用针刺治疗。治疗20天后观察疗效。采用SPSS22.0软件进行数据分析整理前后治疗主观疗效、SCI、BUT结果。结果:28例自觉眼异物感,干涩,视物模糊症状有明显改善,5例未改善,总有效率为84.8%。结论:针灸结合人工泪液治疗干眼症的疗效优于单纯人工泪液。     

去脂软肝汤联合硫普罗宁治疗酒精性肝病的疗效分析

目的观察去脂软肝汤联合硫普罗宁治疗酒精性肝病(ALD)的临床疗效。方法将120例确诊为ALD的患者分为治疗组和对照组,每组各60例,治疗组给予去脂软肝汤联合硫普罗宁治疗,对照组单纯给予硫普罗宁治疗,观察两组患者治疗前后症状、体征、肝功能、血脂改善情况。结果治疗组临床综合疗效总有效率为88.3%,明显高于对照组的51.6%,差异有统计学意义(P0.05)。治疗组中医症候疗效总有效率为83.3%,对照组为46.7%,差异有统计学意义(P0.05)。治疗后两组肝功能和血脂均优于治疗前,但治疗组疗效好于对照组,差异有统计学意义(P0.05)。结论去脂软肝汤联合硫普罗宁治疗ALD在提高临床综合疗效,改善患者各项中医症状等方面明显优于单纯口服硫普罗宁,具有理想的治疗效果,值得临床推广。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.